Cheek alveolar soft part sarcoma recurrence at the primary site during follow-up: a case report and review of the literature.

BACKGROUND: Alveolar soft part sarcoma (ASPS) occurs most often in the deep muscles or fascia of the extremities in adults, with only 3.4% of these tumours originating from the head, face and neck. To date, only 17 cases of buccal ASPS have been reported, including the case presented here. Only one case of ASPS recurrence at the primary site, similar to our case, has been reported thus far. Immune checkpoint inhibitors (ICPis)-associated diabetes, with an estimated incidence of 0.43%, is usually seen in older cancer patients and has not been reported in younger people or in patients with ASPS. CASE PRESENTATION: A 24-year-old male patient presented with a slowly progressing right cheek mass with a clinical history of approximately 28 months. Sonographic imaging revealed a hypoechoic mass, which was considered a benign tumour. However, a pathological diagnosis of ASPS was made after excision of the mass. Five days later, functional right cervical lymph node dissection was performed. No other adjuvant therapy was administered after surgery. In a periodic follow-up of the patient six months later, blood-rich tumour growth was noted at the primary site, and Positron emission tomography-computedtomography (PET-CT) ruled out distant metastasis in other areas. The patient was referred to the Ninth People's Hospital of Shanghai Jiaotong University. Due to the large extent of the mass, the patient received a combination of a Programmed Cell Death Ligand 1(PD-L1) inhibitor and a targeted drug. Unfortunately, the patient developed three episodes of severe diabetic ketoacidosis after the administration of the drugs. A confirmed diagnosis of ICPis-associated diabetes was confirmed. After the second operation, the postoperative pathological diagnosis was ASPS, and the margins were all negative. Therefore, we made a final clinical diagnosis of ASPS recurrence at the primary site. Currently in the follow-up, the patient is alive, has no distant metastases, and undergoes multiple imaging examinations every 3 months for the monitoring of their condition. CONCLUSIONS: In analysing the characteristics of all previously reported cases of buccal ASPS, it was found that the clinical history ranged from 1 to 24 months, with a mean of approximately 3 to 9 months. Tumour recurrence at the primary site has been reported in only one patient with buccal ASPS, and the short-term recurrence in our patient may be related to the extraordinarily long 28-month history. ICPis-associated diabetes may be noted in young patients with rare tumours, and regular insulin level monitoring after use is necessary.

Odontogenic-like neoplasms of the rabbit cheek: pathological features and comparison to cutaneous trichoblastoma and jaw-associated ameloblastoma.

Odontogenic neoplasms demonstrate unique histopathological features and are thought to arise from the germinal tissues of the developing tooth germ, effectively restricting their anatomic origin to the tooth-bearing regions of the jaw and directly associated soft tissues of the oral cavity. Ectopic odontogenic-like neoplasms located in the skin of cats, rabbits, and human beings challenge these assumptions. Here we describe the clinical, pathological, and immunohistochemical features of 6 spontaneously occurring odontogenic-like neoplasms arising in the cutaneous tissue of the cheek in client-owned pet rabbits, including ameloblastoma-like (n = 3), ameloblastic fibroma-like (n = 2), and ameloblastic carcinoma-like neoplasms (n = 1). Microscopically, all the cheek tumors featured neoplastic epithelium exhibiting odontogenic architectural structures (plexiform ribbons, anastomosing trabeculae, follicles, cysts, and irregular structures with rounded botryoid protuberances) and 1 or more cardinal odontogenic epithelial features (basal palisading, antibasilar nuclei, and central stellate reticulum-like cells). The pancytokeratin, cytokeratin 5/6, cytokeratin 14, and vimentin immunohistochemical patterns of these odontogenic-like lesions were most similar to those of jaw-associated ameloblastoma and differed from those of cutaneous trichoblastoma. All neoplasms were narrowly excised, and for lesions with clinical follow-up information, none had evidence of recurrence 1-7 months after surgical removal. Although evidence suggests that these odontogenic-like tumors of the rabbit cheek may be derived from ectopic rests of transformed tooth germ, the histogenesis of these lesions remains unresolved.

Treatment of aseptic facial granuloma as a manifestation of pediatric rosacea with oral macrolides.

Aseptic facial granuloma is a rare pediatric disease, presenting with asymptomatic facial nodules on the cheeks or the eyelids and may represent a form of granulomatous rosacea in children. In this retrospective case series, 12 children with aseptic facial granuloma were treated with oral macrolides (erythromycin or roxithromycin) resulting in a healing of the lesions within a mean treatment time of 5.25 months with no recurrences. The treatment was mainly well tolerated. Oral macrolides may be effective in the treatment of patients with aseptic facial granuloma.

Ultrasonography in the Assessment of Tumors of the Cheek: Water Mouth Distension Technique.

PURPOSE: To describe a new B-mode ultrasound examination technique to assess cheek tumors. MATERIALS AND METHODS: 30 cheek oral cavity lesions of different histological types (11 benign and 19 malignant) from 23 patients (11 women and 12 men, 7-82 years old, mean age of 49.5 years) were analyzed. Transcutaneous oral B-mode ultrasound (5-12 MHz transducer) was carried out in two stages. Initially it was performed conventionally with an empty mouth. Next, the patient was asked to keep their oral cavity filled with water (like when using a mouthwash) during imaging for the new test examination technique. The anatomical layers of this region and the characteristics of the tumors were evaluated. Lesions were classified as ill defined, partially defined, or defined. Conventional findings were compared to those of the new technique using the Wilcoxon signed-rank test. Ultrasound results were compared to histological findings analyzed by an independent team. RESULTS: The conventional empty mouth technique was able to confidently define lesion extension in only 6 of the 30 lesions, while the water-filled mouth technique was able to confidently define lesion extension in 29 of the 30 lesions (p<0.00001). CONCLUSION: We present a novel technique that dramatically improves ultrasound staging of cheek oral cavity tumors. In addition to the increase in ultrasound accuracy, this technique does not require any special equipment or extra cost, is very well tolerated by patients, and thus should be considered in the evaluation of every patient undergoing transcutaneous cheek ultrasound for oral cavity lesion characterization.

Reconstruction of Rapidly Growing Merkel Cell Carcinoma of the Cheek With Multidisciplinary Cooperation.

Merkel cell carcinoma (MCC) is a rare and very aggressive skin cancer. An 83-year-old female presented with a 1.5 cm-sized non-tender mass on her left cheek and was diagnosed with MCC. The margin of MCC was well-defined and there was no cervical node metastasis on pre-operative computed tomography. Three weeks after the first visit, the mass rapidly increased in size. We checked the magnetic resonance imaging, a rapid-growing 2.5 cm sized nodular region and metastatic cervical lymph node were found. We performed wide excision of the MCC and neck lymph need dissection with multidisciplinary cooperation. The soft tissue defect was about 6.0×5.0 cm 2 in size and reconstructed with radial forearm free flap. On permanent biopsy, the size of MCC was 3.0×2.3 cm 2 . There was no recurrence of MCC with radiation therapy during an 18-month follow-up. We experienced an older patient with a rapid - growing MCC and cervical lymph node metastasis in a brief time. With our experience, we discuss the evaluation and treatment plan of the rapid-growing MCC for good results.

Diagnosis and Treatment of Rare Adult Embryonal Rhabdomyosarcoma in Maxillary Sinus.

OBJECTIVE: To investigate the clinicopathological features, imaging features, diagnosis, and prognosis of embryonal rhabdomyosarcoma (ERMS) in the maxillary sinus. METHODS: The detailed clinical data of rare patients with embryonal ERMS of maxillary sinus admitted to our hospital were retrospectively analyzed, and the embryonal ERMS was confirmed by pathological examination and immunohistochemistry, and the relevant literature was reviewed. RESULTS: A 58-year-old man was admitted to the hospital with the chief complaint of "numbness and swelling of the left cheek for 1 and a half months". Blood routine, biochemistry, paranasal sinus computed tomography, and magnetic resonance imaging were performed after admission, and the pathology showed ERMS. At present, it is generally in good condition. Pathological examination showed that the cells were all small and round. Immunohistochemistry showed Desmin (+) and Ki-67 (+70%). CONCLUSION: The early symptoms of ERMS of the maxillary sinus are atypical and diverse, with a high degree of malignancy, rapid progression, strong invasiveness, and poor prognosis. Early diagnosis and treatment should be based on clinical characteristics, imaging examination, and immunohistochemical results.

A newly growing asymptomatic facial lesion.

A 23-year-old man presenting with a 1-year history of a lesion of the right cheek. We highlight this case for awareness as this tumour may mimic other benign lesions, such as pilomatrixoma or benign cysts, as it does not have any uniquely identifying clinical or dermoscopic features. Additionally, it is of concern as malignant transformation can occur and therefore surgery should be considered as both for diagnostic and therapeutic benefit.

'Your mascara is running'.

Chromhidrosis is a rare disorder, which can have significant psychosocial consequences for patients, particularly when it affects the face, as it can be mistaken for scarring, dirt or erroneous make-up application. Chromhidrosis can be divided into apocrine, eccrine and pseudo subtypes. We present a case of apocrine chromhidrosis localized to the bilateral cheek area. Click https://www.wileyhealthlearning.com/#/online-courses/9c761d0a-20de-4709-a57d-36be93cf64e1 for the corresponding questions to this CME article.

Inferiorly Based Rotation Flaps for Infraorbital Cheek Defects.

BACKGROUND: The infraorbital cheek is a common location for cutaneous malignancy and thus surgical defects. Reconstruction in this region must maintain nearby free margins to ensure optimal cosmetic and functional outcomes. Large defects may require a flap using lateral or inferior tissue reservoirs. OBJECTIVE: To examine outcomes of inferiorly based rotation flaps in the repair of infraorbital cheek defects and highlight pearls for optimal long-term results. METHODS: Chart review of patients with a defect of the infraorbital cheek repaired with an inferiorly based rotation flap between February 2010 and December 2018 at a single academic institution. The Visual Analog Scale (VAS) was used for scar assessment. RESULTS: Sixty-five patients underwent extirpation of a cutaneous malignancy resulting in defects ranging from 1.0 × 1.0 to 4.5 × 5.5 cm (mean area = 4.8 cm2). Most of the patients did not experience complications. Ectropion occurred in 7 patients. The mean VAS score was 11.6. CONCLUSION: An inferiorly based rotation flap yields acceptable outcomes for infraorbital cheek defects and can be considered for defects as large as 5.5 cm. Using pearls for surgical execution presented in this article may allow reconstructive surgeons to include this flap in their repertoire.

Treatment of linear and whorled nevoid hypermelanosis using QS 694-nm ruby laser.

Laser is being widely used in treating pigmented lesions nowadays. Linear and whorled nevoid hypermelanosis (LWNH) is a rare pigmentary anomaly, and there are only a handful of cases of successful treatment, all with QS 532- and 755-nm laser. The objective of this study was to examine the clinical outcome of QS 694-nm ruby laser in the treatment of LWNH. We report on a 4-year-old boy presented with asymptomatic macular hyperpigmentation over the entire cheek who underwent 3 treatment sessions with QS 694-nm ruby laser. One month after the last treatment, the patient demonstrated significant improvement to the treatment area. Aside from post-procedural purpura lasting approximately 1 week, the patient experienced no serious adverse effects. No recurrence was observed during the 3-month follow-up. Given the excellent results seen in our patients, we recommended the use of QS 694-nm ruby laser as a safe and effective treatment in patients with LWNH.

Diode Laser Management of Cheek Cavernous Hemangioma in Dental Office.

Due to high energy content and specific characteristics of dental laser light, this kind of procedure optimizes the outcome on oral cavernous hemangioma removal, diminishing the risks, and complications. Management of a very rare internal cheek cavernous hemangioma presenting a high risk of injury in a patient with chronic acenocoumarol medication and high blood pressure, can be accomplished using diode 810nm laser, in the dental office with predictable results. Protocol complied diode laser, with specific fiber tip, specific power, and operation mode, for 1 minute/1 cm 2 irradiated area. Intervention sequences were repeated until complete disappearance. Laser procedure withdrew the lesion rapidly, completely. It has a lot of advantages that recommends it as a removal procedure before prosthetic treatment.

Odontogenic Keratocyst in the Masseter Muscle.

ABSTRACT: Odontogenic keratocyst (OKC) arising from purely soft tissue other than the mucosa covering the jawbone is rare. A 57- year-old Korean female patient presented with a lump on her right cheek, which had been suspected as a fibrotic mass on the buccinator muscle by the local clinic. Magnetic resonance imaging showed an ovoid mass in the buccal space just before the right ramus with an enhancing component in the marginal area, and the interior of the mass revealed a fluid signal. Histopathologically, the lesion showed the typical features of OKC and the cyst wall contained some daughter cysts and the minor salivary gland, muscle, and fat tissues. The authors report a very unique case of OKC arising in the masseter muscle.

The facultative human oral pathogen Prevotella histicola in equine cheek tooth apical/ periapical infection: a case report.

BACKGROUND: Prevotella histicola is a facultative oral pathogen that under certain conditions causes pathologies such as caries and periodontitis in humans. Prevotella spp. also colonize the oral cavity of horses and can cause disease, but P. histicola has not yet been identified. CASE PRESENTATION: A 12-year-old Tinker mare was referred to the clinic for persistent, malodorous purulent nasal discharge and quidding. Conservative antibiotic (penicillin), antiphlogistic (meloxicam), and mucolytic (dembrexine-hydrochloride) treatment prior to referral was unsuccessful and symptoms worsened. Oral examination, radiography, sino-/ rhinoscopy, and standing computed tomography revealed severe apical/ periapical infection of the upper cheek tooth 209 with accompanying unilateral sinonasal inflammation and conchal necrosis. The tooth exhibited extensive subocclusal mesial infundibular cemental hypoplasia and caries, and an occlusal fissure fracture. After mechanical debridement and thermoplastic resin filling of the spacious subocclusal carious infundibular lesion, the tooth was extracted intraorally. The sinusitis and conchal necrosis were treated transendoscopically. Selective bacteriological swab cultures of affected tooth roots and subsequent matrix-assisted laser desorption ionization-time of flight mass spectrometry showed an infection with the obligate anaerobic, Gram-negative bacterium P. histicola. Surgical intervention and adapted antibiotic therapy led to normal healing without complications. CONCLUSIONS: This study provides the first documented case of dental infection in a horse caused by P. histicola at once indicating necessity of more sufficient microbiological diagnostics and targeted antibiotic treatment in equine dental practice. This finding is also conducive to understand species-specific Prevotella diversity and cross-species distribution.

Thymoquinone loaded calcium alginate and polyvinyl alcohol carrier inhibits the 7,12-dimethylbenz[a]anthracene-induced hamster oral cancer via the down-regulation of PI3K/AKT/mTOR signaling pathways.

Oral cancer is a multifactorial cancer that affects millions of peoples worldwide. The current exploration aimed to evaluate the mechanisms that thymoquinone nanoencapsulated carrier and its effects on 7,12-Dimethylbenz[a]anthracene (DMBA) stimulated hamster buccal pouch cancer in Syrian hamster model. Nanocarrier was characterized by SEM, TEM, FTIR analysis. The incidence of tumor, and biochemicals makers was studied through standard methods. The mRNA expression level of inflammatory markers NF-κBp50, NF-κBp65, and PI3K/AKT/mTOR markers in the buccal tissues of control and experimental animals were investigated through RT-PCR analysis. In thymoquinone (TQ) loaded calcium alginate and polyvinyl alcohol carrier (TQ/Ca-alg-PVA) no squamous cell carcinogenesis developed and others moderate dysplasia revealed differentiated form of hyperplasia and keratosis. In biochemical analyses with DMBA + TQ/Ca-alg-PVA (20 mg/kg bw) orally administered hamsters showed restored the antioxidants, detoxification, xenobiotic metabolising enzymes in DMBA induced plasma and oral tissues of hamsters. Further, mRNA expression level of NF-κBp50/p65 and PI3K/AKT/mTOR were upregulated in the DMBA alone painted hamster. In contrast, these expressions were down regulated in orally TQ/Ca-alg-PVA treated experimental animals. This ability more eligible to deregulate the inflammatory and PI3K/AKT/mTOR signaling pathway that proved it suppresses anti-invasion/metastasis activity during hamster buccal pouch carcinogenesis. From this study, we recommended that TQ/Ca-alg-PVA has documented as effective chemopreventive agents, in further many molecular machineries need to study.

Symmetric facial macules in an Asian woman.

Hori nevus, also known as acquired bilateral nevus of Ota-like macules, is a form of dermal melanocytosis found most commonly in women of East Asian heritage. It presents as discrete brown macules on the bilateral cheeks which later coalesce into confluent grey-brown macules and small patches. Herein, we report a classic case of Hori nevus and discuss the histologic findings and differential diagnosis. We also review the proposed pathophysiology, genetic considerations, and treatment options.

Forehead location and large segmental pattern of facial port-wine stains predict risk of Sturge-Weber syndrome.

BACKGROUND: Children with forehead port-wine stains (PWSs) are at risk of Sturge-Weber syndrome (SWS). However, most will not develop neurologic manifestations. OBJECTIVE: To identify children at greatest risk of SWS. METHOD: In this retrospective cohort study of children with a forehead PWS, PWSs were classified as "large segmental" (half or more of a contiguous area of the hemiforehead or median pattern) or "trace/small segmental" (less than half of the hemiforehead). The outcome measure was a diagnosis of SWS. RESULTS: Ninety-six children had a forehead PWS. Fifty-one had a large segmental PWS, and 45 had a trace/small segmental PWS. All 21 children with SWS had large segmental forehead PWSs. Large segmental forehead PWSs had a higher specificity (0.71 vs 0.27, P < .0001) and a higher positive predictive value (0.41 vs 0.22, P < .0001) for SWS than any forehead involvement by a PWS. LIMITATIONS: Retrospective study at a referral center. CONCLUSION: Children with large segmental forehead PWSs are at highest risk of SWS.

Quantitative evaluation of atrophic acne scars using 3D image analysis with reflected LED light.

BACKGROUND: Methods for objective evaluation of acne scars have not been established yet. In this study, the capability of three-dimensional image analysis of acne scarring was examined. METHODS: Two dermatologists evaluated the severity and counted the number of atrophic acne scars in a defined evaluation area of each cheek (3.5 cm × 3.5 cm) of 22 subjects (age, 21-38 years). Images of the evaluation area were obtained with an Antera 3D® (Miravex Limited, Ireland) camera three times, and three parameters (affected area, volume, and max depth) were measured. Three different filters (small, medium, and large), which limit measurement targets based on the diameters of concavities, were used for measurement. The relationships between each parameter and the evaluation results of scars by dermatologists were analyzed using Spearman's correlation coefficients. RESULTS: The correlations between the evaluation results of scars by dermatologists and each parameter measured were the highest when the large filter was used. The correlation coefficients between the severity of scars by dermatologists and each of affected area, volume, and max depth were 0.736, 0.728, and 0.722, respectively, and those between scar counts and each of affected area and volume were 0.783 and 0.770, respectively. The correlations, scatter plots, and regression lines among three measurements of parameters suggested high repeatability. CONCLUSIONS: Three-dimensional image analysis has the capability to evaluate changes in the shape of scars before and after treatment quantitatively.

Rapid Evolution of a Squamous Cell Carcinoma In Situ to Locally Invasive With Perineural Involvement.

We present a case of rapidly progressing squamous cell carcinoma in situ (SCCis) with progression to aggressive SCC. An elderly gentleman with multiple medical comorbidities presented with a left zygomatic tumor initially diagnosed as SCCis with adnexal extension on histology. After a period of approximately 10 weeks, the patient underwent Mohs micrographic surgery (MMS) with evidence that the tumor was now consistent with a well-differentiated SCC, with perineural involvement. MMS was stopped after two stages and the patient was sent to head and neck surgical oncology for further evaluation and management. It has been reported in the literature that 3–5% of SCCis will progress to invasive SCC; although the inciting event to cause such progression is unknown, it is thought that mutations in key oncogenes or tumor suppressor genes such as TP53 may play a role. In addition, as many as 31% of SCCis may have a component of invasive SCC that is missed on initial histology due to sampling bias. This case reminds us that sampling bias can occur during biopsy, SCCis can rarely progress to invasive SCC, and highly aggressive SCCs may prove to be therapeutically challenging requiring a multidisciplinary approach. J Drugs Dermatol. 2020;19(11):1110-1111. doi:10.36849/JDD.2020.5184.

The anatomic distribution of cutaneous melanoma: A detailed study of 5141 lesions.

BACKGROUND/OBJECTIVES: There is evidence that cutaneous melanomas at different anatomic sites present with distinctive clinicopathologic features. We examined the anatomic distribution of cutaneous melanoma and its variation by patient characteristics, subtype and Breslow thickness, using high-resolution anatomic site data. METHODS: A cross-sectional study was performed of all primary cutaneous melanoma cases managed at a tertiary referral centre, analysing prospectively collected clinical data across 50 anatomic subsites. RESULTS: The study included 5141 in situ or invasive melanomas; most were invasive (76.2%), and the median Breslow thickness of invasive lesions was 1.0 mm. Superficial spreading (57.2%), lentigo maligna (20.8%) and nodular (12.2%) were the most common histopathological subtypes. Sun-exposed sites such as the female nose and cheek, the male ear, as well as the upper back in both sexes had the highest incidence of melanoma per unit area. When compared to the posterior forearm, the scalp, ear, preauricular, perioral, subungual and plantar sites had thicker invasive melanomas (each P < 0.05). The peri-auricular, ear and cheek had the highest incidence of nodular melanoma per unit area. There were subtype-, age- and sex-specific differences in melanoma anatomic distribution. CONCLUSION: Melanoma most commonly arises in sun-exposed facial areas, as well as the upper back. Increased thickness is found for melanoma in acral and many head and neck sites. Nodular melanoma is more likely to occur in head and neck sites including the peri-auricular area, ear and cheek. Clinicians should carefully assess these sites during skin examinations.

Surgical Treatment of Oral Cavity Nodular Fasciitis.

BACKGROUND: Nodular fascitiis is a myofibroblastic neoplasm of the soft tissue that rarely affects oral cavity. With a broad pattern of presentation, sometimes Nodular Fascitiis can have a rapid growth and appear highly cellular with local aggressiveness on biopsies, thus simulating a sarcoma. The aim of this paper is to present a case of troublesome diagnosis of nodular fascitiis mimicking a Malignant Fibrous Histiocytoma, with the purpose of alert clinicians and pathologists on the difficulties that can be met in the differential diagnosis between these 2 lesions. A 42-year-old male presented an exophytic lesion on the cheek. After the excisional biopsy, histological and immunohistochemical evaluations revealed a picture of doubtful significance. With a careful analysis, the diagnosis of nodular fasciitis was made and the patient was not further treated. At a 3-year follow-up, no recurrence was found. Differential diagnosis within myofibroblastic neoplasm can be a real challenge for both Clinicians and Pathologist. A coordinated team-work is mandatory to avoid clinical malpractice and unnecessarily aggressive treatment.